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Updated: Apr 4, 2026
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Temporal Association Between Reflux-like Behaviors and Gastroesophageal Reflux in Preterm and Term Infants
Apryle Funderburk1, Ursula Nawab, Sheeja Abraham
1*Department of Neonatology †Department of Pediatric Gastroenterology and Nutrition, Thomas Jefferson University/Nemours, Philadelphia, PA.
Insights
Gastroesophageal reflux (GER) diagnosis in infants using multichannel intraluminal impedance (MII-pH) studies showed a low prevalence (10%). Most observed reflux-like behaviors in infants did not correlate with actual reflux events detected by MII-pH.
Area of Science:
- Pediatrics
- Gastroenterology
- Diagnostic Medicine
Background:
- Gastroesophageal reflux (GER) is commonly diagnosed in infants using multichannel intraluminal impedance (MII-pH) studies.
- Infantile symptoms like irritability, bradycardia, and desaturation are often attributed to GER.
- However, the correlation between these clinical signs and actual reflux events requires further investigation.
Purpose of the Study:
- To correlate observed reflux-like behaviors in infants with confirmed reflux events identified through MII-pH studies.
- To determine the prevalence of GER in symptomatic preterm and term infants.
Main Methods:
- A retrospective study involving 58 infants evaluated for GER using MII-pH.
- Infants' clinical behaviors were observed during MII-pH monitoring.
- Symptom association probability (SAP) was used to correlate symptoms with reflux events.
Main Results:
- Only 10% of infants (6 out of 58) presented with abnormal MII-pH findings.
- Irritability, bradycardia, and desaturation were common symptoms, but SAP was abnormal in only 19%, 5%, and 28% of cases, respectively.
- The majority of recorded clinical reflux behaviors did not correlate significantly with MII-pH detected reflux events.
Conclusions:
- The prevalence of GER, as confirmed by MII-pH, is low in symptomatic infants.
- Observed clinical behaviors suggestive of reflux in infants frequently do not correspond to actual reflux events.
- These findings suggest a need to re-evaluate the diagnostic criteria for GER in infants based on clinical presentation alone.
Objectives:
Multichannel intraluminal impedance studies (MII-pH) have become the criterion standard for the diagnosis of gastroesophageal reflux (GER). Several clinical signs and symptoms that are attributed to GER during infancy may not be related to true reflux. Our objective was to correlate the observed reflux-like behaviors to reflux events on MII-pH studies.
Methods:
This is a retrospective study on infants being evaluated for GER with MII. During the MII-pH study, the infants were observed for clinical behaviors. Symptom Index (SI), symptom sensitivity index (SSI), and symptom association probability were used to correlate symptoms with reflux events.
Results:
Of 58 infants (40 preterm, 18 term) included in the study, only 6 infants (10%) had an abnormal MII-pH study. Irritability (32 infants), bradycardia (20), and desaturation (18) were the common signs and symptoms. A total of 2142 (755 acidic and 1386 nonacidic) reflux episodes and 953 clinical reflux behaviors were recorded. The incidence and pattern of GER was similar in preterm and term infants. There was no significant difference in GER episodes and acid exposure in preterm infants fed orally or via nasogastric tube. The symptom association probability was abnormal in only 6 (19%), 1 (5%), and 5 (28%) infants with irritability, bradycardia, and desaturation, respectively.
Conclusions:
The prevalence of GER as detected by MII-pH was low (10%) in symptomatic preterm and term infants. The incidence and pattern of GER was similar in preterm and term infants. The majority of suspected clinical reflux behaviors did not correlate with reflux events.
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